Abstract
Background. Tuberculosis (TB) disease diagnosis in Vietnam relies on symptom screening, chest radiography (CXR), and acid fast bacilli (AFB) sputum smear which have a poor sensitivity in HIV patients. We evaluated the performance of clinical algorithms in screening and diagnosing AFB smear-negative TB in HIV patients. Methods. We enrolled 399 HIV-positive patients seeking care at a HIV clinic in Ho Chi Minh City (HCMC), Vietnam. Participants' demographics, medical history, common TB symptoms, CXR, and laboratory tests were collected. Results. Of 399 HIV patients, 390 had initial AFB-negative smears and 22/390 patients had positive cultures. Symptom screening missed 54% (12/22) of smear-negative pulmonary TB (PTB) cases. Multivariate analysis found CD4+ cell level and CXR were significant PTB predictors. An algorithm combining four TB symptoms and TST presented a high sensitivity (100%), but poorly specific (24%) diagnostic performance for smear-negative PTB. Conclusion. Up to 54% of PTB cases in the HIV-infected population may be missed in the routine screening and diagnostic procedures used in Vietnam. Symptom screening was a poor overall diagnostic measure in detecting smear-negative TB in HIV patients. Our study results suggest that routine sputum cultures should be implemented to achieve a more accurate diagnosis of TB in HIV patients.
Highlights
HIV-infected patients with tuberculosis (TB) coinfection may present with atypical manifestations of pulmonary TB (PTB) and a higher rate of negative sputum smears for acid fast bacilli (AFB) [1,2,3]
A total of 639 HIV-infected patients who registered as District 6 residents and sought care at the An Hoa Clinic during the study timeframe were screened for eligibility by the study staff
Among 436 HIV-patients eligible by the inclusion criteria who agreed to participate in the study, 37 patients were excluded due to incomplete procedures (6 withdrew before having the interview, 26 attended the interview withdrew without having any test done, 4 missed CXR, and 1 missed sputum culture result)
Summary
HIV-infected patients with tuberculosis (TB) coinfection may present with atypical manifestations of pulmonary TB (PTB) and a higher rate of negative sputum smears for acid fast bacilli (AFB) [1,2,3]. The diagnosis of TB disease in developing countries like Vietnam relies mainly on symptom screening, chest radiography (CXR), and AFB sputum smear, which have a poor sensitivity in HIV-positive patients [3, 7]. Tuberculosis (TB) disease diagnosis in Vietnam relies on symptom screening, chest radiography (CXR), and acid fast bacilli (AFB) sputum smear which have a poor sensitivity in HIV patients. Up to 54% of PTB cases in the HIV-infected population may be missed in the routine screening and diagnostic procedures used in Vietnam. Our study results suggest that routine sputum cultures should be implemented to achieve a more accurate diagnosis of TB in HIV patients
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